Low-Cost Fast Shipping | $4.95 or Free on orders $99+

Hyperhidrosis in Adults : Current Evidence-Based Treatment Options

Skin Conditions, General | July 26, 2014 | Author: The Super Pharmacist

Skin conditions, skin

Hyperhidrosis in Adults : Current Evidence-Based Treatment Options

Why Do Human Beings Sweat? The main purpose of sweating is the regulation of body temperature. Sweating causes a decrease in core body temperature through evaporative cooling of liquid sweat at the skin surface.

All warm-blooded creatures, like mammals, must maintain a constant body temperature for survival. In cooler environments, this is accomplished by converting food into energy which generates heat. In hotter environments, cooling is achieved by means of sweating (humans), panting (dogs), licking (cats and rabbits), or bathing (pigs and elephants). Primates, such as humans, apes and monkeys, rely on sweating for temperature regulation much more than other animals. 

There are two main types of sweat glands in humans. Eccrine and Apocrine

Eccrine glands secrete sweat through pores found in the palms of hands, soles of feet, and forehead. They secrete a clear, watery, odorless fluid containing small amounts of salt (sodium chloride). Eccrine sweat glands open through pores directly onto the surface of the skin, releasing sweat for rapid evaporation to cool the skin and lower body temperature.

Apocrine glands are present only under the arms and in the genital region. Although present from birth, they are nonfunctional until puberty. The apocrine sweat glands empty into hair follicles rather than directly onto the skin’s surface. The sweat produced by the apocrine glands contains lipids (fats) and proteins that mix with the sebaceous fluids in the hair follicles to reach the skin’s surface. Bacteria on the surface of the skin consume the lipids and proteins, creating waste byproducts that are responsible for the characteristic odor associated with sweating.

What is Hyperhidrosis?

Hyperhidrosis is a medical condition in which a person sweats excessively and unpredictably. Hyperhidrosis can be divided into two main categories – local or general hyperhidrosis.

What is Hyperhidrosis?Local hyperhidrosis is usually limited to one or a few regions of the body. Most commonly, local hyperhidrosis affects the armpits, groin, hands, face and/or feet. These areas have higher concentrations of eccrine sweat glands than other areas of the body and may explain their involvement. 

Hyperhidrosis can be further classified as primary or secondary.

  • Primary hyperhidrosis, the cause is unknown. This is commonly referred to as idiopathic hyperhydrosis. Typically, the excessive sweating is localised to the armpits, hands, face, and/or feet. Primary hyperhidrosis begins in childhood or early adolescence, worsens during puberty, and lasts a lifetime.
  • Secondary hyperhidrosis is less common than primary hyperhidrosis, excessive sweating is caused by another medical condition and usually occurs over the entire body.

Medical conditions that can cause secondary hyperhidrosis include:

  • Hyperthyroidism
  • Menopause
  • Obesity
  • Psychiatric disorders
  • Diabetes
  • Secondary hyperhidrosis may also be caused by certain medications

Almost 3% of the general population, largely people aged between 25 and 64 years, experience hyperhidrosis. However, patients rarely seek a physician's help because many are unaware that they have a treatable medical disorder.

Regardless of the form, hyperhidrosis often causes great emotional distress and occupational disability for the people.

What is Hyperhidrosis?Social and business interactions can be affected.

For instance, if hyperhidrosis affects the hands, individuals avoid hand shaking due to sweaty palms. 

Excessive sweating can cause individuals to avoid public speaking engagements for fear of embarrassment of sweating in front of an audience.

What Causes Hyperhidrosis?

The physiology of hyperhidrosis is poorly understood. It is believed to be related to abnormal activation of the sympathetic nerves that supply both the eccrine and apocrine glands. It may also result from abnormalities anywhere along the pathway involved with sweat control, namely brain, spinal cord, peripheral nerves or the glands themselves.

How Is Idiopathic Hyperhidrosis Treated?

There are several common treatments that can be tried to effectively reduce the impact of symptoms of excessive sweating, including the following:

Topical agents

Excessive sweating may be controlled with strong anti-perspirants, which plug the sweat ducts. Products containing 10% to 20% aluminum chloride hexahydrate are the first line of treatment for underarm sweating.


Medications may be taken orally to block the neurotransmitter, acetylcholine, from stimulating the sweat glands. Anticholinergics such as propantheline bromide, glycopyrrolate, oxybutynin, and benztropine are effective because the preglandular neurotransmitter for sweat secretion is acetylcholine (although the eccrine glands are also supplied by adrenergic nerve fibers containing catecholamines). 

  • Adverse side effects of anticholinergics include blurry vision, dry mouth and eyes, difficulty with urination, and constipation.

In addition, other systemic medications, such as sedatives and tranquilisers, indomethacin, and calcium channel blockers, may be beneficial in the treatment of palmoplantar (hand and foot) hyperhidrosis.


Iontophoresis consists of passing a direct current across the skin. This is most easily used for the palms and soles. Units can be purchased for use within the home.

In this procedure, the hands or feet are placed into tap water or tap water with anticholinergics, and then a gentle current of electricity is passed through the liquid. The electricity is gradually increased until the patient feels a light tingling sensation. The therapy lasts about 10 to 20 minutes and requires several sessions. The electric current is believed to disrupt the function of the sweat glands, but the exact mechanism of action is under debate. By using this machine a few times per week, dryness in the area of treatment can be obtained that can last for several weeks. Numerous agents have been used including tap water and anticholinergics; however, treatment with anticholinergic iontophoresis is more effective than tap water iontophoresis. In palmoplantar hyperhidrosis, the daily treatment of each palm or sole for 30 minutes at 15-20 mA with tap water iontophoresis is effective. 

  • Side effects include skin cracking and blisters, although rare.


Botulinum toxin type A (Botox) is used to treat severe underarm sweating. This condition is called primary axillary hyperhidrosis. Botulinum toxin injections are effective because of their anticholinergic effects which block nerve conduction to the sweat glands.Botox

  • Side effects include injection-site pain, flu-like symptoms and mild but temporary weakness.

A substantial increase in the duration of efficacy may be produced by repetitive injections in patients with primary palmar hyperhidrosis. Injections of botulinum toxin A reconstituted in lidocaine are associated with significantly reduced pain, which may be preferable for treating axillary hyperhidrosis.

Injections of botulinum toxin must be repeated at varying intervals to maintain long-term results.

Endoscopic thoracic sympathectomy (ETS) The nerve supply to the sweat glands can be interrupted by cutting or destroying the sympathetic nerves. This procedure is known as a sympathectomy. Sympathectomy has been used as a permanent effective treatment since 1920. Usually, it is reserved as the final treatment option. This procedure turns off the signal that tells the body to sweat excessively. It is usually performed on patients whose palms sweat much more heavily than normal. It may also be used to treat extreme sweating of the face. ETS does not work as well for those with excessive armpit sweating.

  • Side effects such as excessive sweating in previously unaffected areas (known as compensatory hyperhidrosis) can result.

Underarm surgery This surgery removes the sweat glands in the armpits. Methods used include laser, curettage (scraping), excision (cutting), or liposuction. Compared with classic surgical excision, subcutaneous liposuction causes less disruption of the overlying skin, resulting in smaller surgical scars and a diminished area of hair loss.

How Is Secondary Hyperhidrosis Treated?

Secondary hyperhidrosis can often be treated, although the right approach depends on the condition causing it. For instance, hyperhidrosis caused by an overactive thyroid may be resolved by treating the thyroid with medication or surgery. Excessive sweating caused by diabetes may disappear once glucose levels are under control.

www.superpharmacy.com.au Australia's best online pharmacy


Warm and cold-blooded. CoolCosmos. http://coolcosmos.ipac.caltech.edu/image_galleries/ir_zoo/coldwarm.html. (n.d.) Accessed 10 July 2014.

Horowitz DM. Hyperhidrosis. MedlineEncyclopedia. http://www.nlm.nih.gov/medlineplus/ency/article/007259.htm. Updated 21 May 2013. Accessed 10 July 2014.

Two types of hyperhidrosis. International Hyperhidrosis Society. http://sweathelp.org/en/home/types-of-hyperhidrosis.html. 2013-2014. Accessed 10 July 2014.

Lear W, Kessler E, Solish N, Glaser DA. An epidemiological study of hyperhidrosis. Dermatol Surg.  2007; 33(1 Spec No.):S69-75.

Excessive sweating (hyperhidrosis). SkinSight. http://www.skinsight.com/adult/hyperhidrosis.htm. Published 23 Dec 2009. Accessed 10 July 2014.

Hyperhidrosis. Cleveland Clinic. https://www.clevelandclinic.org/thoracic/general/Hyperhidrosis.htm. Published 2007. Accessed 10 July 2014.

Hyperhidrosis. AllAboutSweat.com. http://allaboutsweat.com./hyperhidrosis.html. Published 2011. Accessed 10 July 2014.

Klaber M, Catterall M. Treating hyperhidrosis. Anticholinergic drugs were not mentioned. BMJ. Sep 16 2000;321(7262):703.

Wozniacki L, Zubilewicz T. Primary hyperhidrosis controlled with oxybutynin after unsuccessful surgical treatment. Clin Exp Dermatol. Dec 2009;34(8):e990-1.

Bouman HD, Lentzer EM. The treatment of hyperhidrosis of hands and feet with constant current. Am J Phys Med. Jun 1952;31(3):158-69.

Karakoç Y, Aydemir EH, Kalkan MT, Unal G. Safe control of palmoplantar hyperhidrosis with direct electrical current. Int J Dermatol. Sep 2002;41(9):602-5.

Murphy R, Harrington CI. Treating hyperhidrosis. Iontophoresis should be tried before other treatments. BMJ. Sep 16 2000;321(7262):702-3.

Abell E, Morgan K. The treatment of idiopathic hyperhidrosis by glycopyrronium bromide and tap water iontophoresis. Br J Dermatol. Jul 1974;91(1):87-91.

Sato K, Ohtsuyama M, Samman G. Eccrine sweat gland disorders. J Am Acad Dermatol. Jun 1991;24(6 Pt 1):1010-4.

Fujita M, Mann T, Mann O, Berg D. Surgical pearl: use of nerve blocks for botulinum toxin treatment of palmar-plantar hyperhidrosis. J Am Acad Dermatol. Oct 2001;45(4):587-9.

Moraru E, Voller B, Auff E, Schnider P. Dose thresholds and local anhidrotic effect of botulinum A toxin injections (Dysport). Br J Dermatol. Aug 2001;145(2):368.

Naumann M. Evidence-based medicine: botulinum toxin in focal hyperhidrosis. J Neurol. Apr 2001;248 Suppl 1:31-3.

Naumann M, Lowe NJ. Botulinum toxin type A in treatment of bilateral primary axillary hyperhidrosis: randomised, parallel group, double blind, placebo controlled trial. BMJ. Sep 15 2001;323(7313):596-9.

Lecouflet M, Leux C, Fenot M, Célerier P, Maillard H. Duration of efficacy increases with the repetition of botulinum toxin A injections in primary palmar hyperhidrosis: A study of 28 patients. J Am Acad Dermatol. Mar 12 2014.

Kotzareff A. Resection partielle de trone sympathetique cervical droit pour hyperhidrose unilaterale. Rev Med Suisse Romande. 1920;40:111-3.

Chen HJ, Lu K, Liang CL. Transthoracic endoscopic T-2, 3 sympathectomy for facial hyperhidrosis. Auton Neurosci. Oct 8 2001;93(1-2):91-4.

Hsu CP, Shia SE, Hsia JY, Chuang CY, Chen CY. Experiences in thoracoscopic sympathectomy for axillary hyperhidrosis and osmidrosis: focusing on the extent of sympathectomy. Arch Surg. Oct 2001;136(10):1115-7.

Kim BY, Oh BS, Park YK, Jang WC, Suh HJ, Im YH. Microinvasive video-assisted thoracoscopic sympathicotomy for primary palmar hyperhidrosis. Am J Surg. Jun 2001;181(6):540-2.

Lillis PJ, Coleman WP 3rd. Liposuction for treatment of axillary hyperhidrosis. Dermatol Clin. Jul 1990;8(3):479-82.

backBack to Blog Home